*Individual Name:

*Organization Name:

*Address:

*City:

*State:

*ZIP:

*Phone Number:

*E-mail Address:

*Data Information:
Please provide detailed information about the records being requested in order to aid staff in determining if such records exist and are possessed by the agency. Requests for records not yet in existence or documents to be created prospectively cannot be honored.

Format for receiving data information:

Requestor Pick-up
(25¢ per page of photocopies or printed copies)

Mailing
(41¢ for the first five pages; 25¢ per each additional five-page increment)

Fax
(25¢ per page, maximum 15 pages)

E-mail
(no charge per page or record)

Note: The person making the request will also be charged $18 per hour in 30-minute increments for staff time.